The Private Sector and UHC: what was discussed at the 5th Global Symposium on Health Systems Research?

Hundreds of health system researchers, funders and policy makers attended the Fifth Global Symposium on Health Systems Research in Liverpool. I was privileged to be one of the SPEED members who attended this year’s symposium. Among the sessions I attended, a plenary session on private sector engagement in health interested me. From the discussions held, it was very clear that the private sector is indeed providing services that are demanded by the community notwithstanding the challenges within the sector. It was noted that both the private and the public sector are paramount if countries are to achieve UHC.

The following issues really stood out;

The question of who provides the service may not be as important as the questions about the type of services they are providing in relation to the services needed by the population at need, the quality of the service they are providing, how these services are purchased and who is paying for these services.

The type of provider does not really matter so long as all these issues are adequately and appropriately addressed.

Participants exchanging ideas at the Symposium

Several prominent speakers made contributions on different aspects of private sector engagement:

Professor Catherine Goodman of London School of Hygiene and Tropical Medicine demonstrated that the contributions of the private sector varies with country, type of service provided and type of person utilizing the provided services. Certainly the picture is different between continents and even within countries. She demonstrated the role that the public and private sectors need to play in providing different types of services. Regulations and incentives need to be right to ensure that private sector promote equitable utilization and provision of quality services.

Mr Zoidze- a Member of Parliament from Georgia, shared vivid examples of what can happen when a country puts in place incentives that favor investment for the private sector without the required checks to mitigate catastrophic expenditure and unnecessary use of technology. She narrated that in their country, over 90% of health services are currently provided by a private sector that is profit oriented contributing to high rates of catastrophic health expenditure of about 30%.

Professor Kara Hanson of London School of Hygiene & Tropical Medicine likened this to the “Gin getting out of the bottle and trying to put the gin back into the bottle”. She questioned whether it is the fault of the private sector if things get out of hand.

Mr Gitahi from the African Medical and Research Foundation (AMREF) said blaming the private sector for grabbing existing opportunities for investment is just like “putting milk before a cat and blaming the cat for drinking the milk”.

This session discussion had implications for attainment of UHC in Uganda in a number ways;

There should be mechanisms to optimally engage the private sector without compromising public interests and sustainability of joint interventions.

There is a need to build capacity to regulate the private sector activities; not only for them to make profits but also to prioritize the needs of the vulnerable.

Dr Elizabeth Ekirapa Kiracho

Health Economist- SPEED project and Chair, Department of Health Policy and Planning, Makerere University School of Public Health